Dopamine Agonists

What are the facts?

  • Dopamine agonists are a different class of drugs than levodopa.
  • While levodopa is converted in the brain into dopamine, dopamine agonists actually mimic the effects of dopamine without having to be converted.
  • Dopamine agonists are often the first medication prescribed to treat PD, but can also be used in later stages of PD with carbidopa/levodopa.

The following are the most commonly prescribed dopamine agonists in the U.S. :

  • Pramipexole (Mirapex®)
    • Approved by the FDA in 1997
    • Effective in the early treatment of the motor symptoms of PD and plays an important role in controlling motor fluctuations.
  • Ropinirole (Requip®)
    • Approved by the FDA in 1997
    • Effective in the early treatment of the motor symptoms of PD and plays an important role in controlling motor fluctuations.
  • Rotigotine (Neupro® patch)
    • Formulated as a once-daily transdermal (skin) patch that is changed every 24 hours.
    • Clinical trials have shown Neupro is just as effective as the oral dopamine agonists: pramipexole and ropinirole.
    • The most common side effect is skin irritation, which is usually mild. Patients are able to tolerate the patch better when they rotate the sites where they adhere the patch.
    • Although the patch was recalled in 2008 because of a manufacturing and quality control issue, , it was reintroduced to the U.S. market in 2012, following improvements and a study of the new formulation.
  • Apomorphine (Apokyn®)
    • Apomorphine was first used to treat PD in 1950, but its use was associated with many side effects, especially nausea and vomiting.
    • In the 1990s apomorphine was released in a self-injectable form. It is now used as a “rescue” drug for people with advanced PD and severe “off” episodes.
    • It can be used as many as five times per day as a “rescue” agent.

Dopamine agonists can be used effectively as a single drug in early stages of PD or in combination with carbidopa/levodopa later on.

What are the Side Effects?

  • Excessive daytime sleepiness
  • Visual hallucinations
  • Confusion
  • Swelling of the ankles
  • Dyskinesia (not as common)
  • Compulsive behaviors (such as uncontrolled shopping, gambling, eating, and sexual urges.)

Note: Pergolide and Bromocriptine are no longer available in the U.S. as treatment for PD.

Caution: PD medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over the counter cold pills and other remedies.  Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions.

Want to Learn More?

Medical content reviewed by: Nina Browner, MD—Medical Director of the NPF Center of Excellence at the University of North Carolina at Chapel Hill in North Carolina and by Fernando Pagan, MD—Medical Director of the NPF Center of Excellence at Georgetown University Hospital in Washington, D.C.

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